Pediatrics: Lots of Sore Throats
Editor's Note: This is the final story in a series of Friday articles on local people going about their daily jobs.
The common cold couldn't be more common to Dr. Joe Boals.
A pediatrician at Sandhills Pediatrics on West Illinois Avenue in Southern Pines, Boals says his daily routine is dominated by colds, sore throats, ear infections and asthma.
"Medicine is pattern recognition," Boals says. "It's not a lot of genius; it's a lot of doing the same thing over and over and over again. When you get the difficult case, a case that presents itself differently than it's supposed to, that's when things get hard."
The children he has lined up today shouldn't be difficult cases. In fact, they should be downright enjoyable.
"The fun thing about pediatrics is that all our patients are cute," Boals says as he heads down the hall to check on a blue-eyed beauty named Victoria Hardy.
He flashes a smile as he enters the room, dressed not in a long, white lab coat but in khaki pants and a plaid button-up shirt.
Victoria, almost 2 years old, has been pulling on her ears and has a fever, her grandmother, Linda, says. As Boals gets down on one knee to check Victoria, she tears up, saying, "No, no, no!"
Boals knows just what to do. He turns on his otoscope, the lighted apparatus he uses to peer into ears, and offers it to the petrified girl to touch. Boals then plays magician, blowing on the light as he slyly clicks off the switch. In the youngster's mind, he has just extinguished the light like a candle.
After that, Victoria's fear fades, and she allows him to look at her ears and her very red throat.
"One of the biggest challenges is trying to see kids without upsetting them too much," Boals says later, "because you get a better exam if you don't upset them."
The exam reveals that it's not strep throat, and Boals gives advice on the best methods for easing Victoria's discomfort -- some of which go against traditional practices.
"We don't recommend giving baths for fevers," Boals says to the grandmother. "That's old-fashioned stuff. Giving a bath during a fever, unless you have the water temperature right, will actually drive the fever up. But fever is absolutely harmless. There's nobody since the beginning of time that's been harmed by a fever."
In fact, much of Boals' work consists of dispelling commonly held beliefs about children's health and behavior. Among them -- what the best drink is for kids.
"Be careful with milk," Boals says. "Milk is something that's great for cows. It's OK for children. Two cups a day is all they need."
He also must often tell people that vaccines don't cause autism, that solid foods don't help babies sleep through the night and that kids shouldn't transition from a crib until 3 years old.
"Child behavior is pretty straightforward, although parents make it seem complicated," Boals says.
Boals gets another opportunity to share some parenting tips with Stacey Goodwin, who asks about the temper tantrums that sometimes erupt from her son Vance, who is a month shy of 2 years old.
"Turn your back on him and walk away," Boals advises. "Poppin' them will not help. Punishment has to last for it to be effective. It has to last one to two minutes for every year of age. You've got to not give in. You out-stubborn them."
After listening, Goodwin responds, "Did you write a book?"
"I learned most of this from my wife," Boals admits.
'They Outgrow You'
Learning from his family has helped him as a pediatrician, and being a pediatrician has helped him with his family, Boals says. He and his wife, Susie, have two kids: a 14-year-old son, Bo, and a 12-year-old daughter, Chris.
In addition to the education received in his own home, Boals attended the University of North Carolina at Charlotte, where he completed his bachelor's degree in chemistry in two and a half years. He attended medical school at the University of Tennessee at Memphis, then trained at Le Bonheur Children's Medical Center there.
But before he decided to become a doctor, Boals dropped out of school for 10 years and worked in a variety of jobs, including as a waiter and bartender. That hiatus made him 38 when he started practicing at Sandhills Pediatrics in 1996.
Despite getting started later than most doctors, Boals says he's been able to establish lasting relationships with many patients during his 12-year career.
"It's kind of sad and it's kind of fun to watch everybody grow up," Boals says. "They eventually outgrow you, but hopefully they'll bring their babies back to see you."
'Easy to Talk With'
The next of Boals' appointments today is with some of those very children he has watched grow up. Andrea Faulkner of Pinehurst has been bringing her children to Sandhills Pediatrics for almost nine years. Today it's her 9-year-old son Noah's turn for an asthma checkup.
"We mainly see Dr. Boals because he has a background in asthma," Faulkner says. "I just think that pediatricians know a little bit more about kids than just a general doctor. He's really easy to talk with."
Boals must now switch gears to deal with a patient he can speak to like an adult. The blow-out-the-light trick isn't needed.
"When you're running, are you coughing any?" Boals asks, putting his stethoscope to the boy's chest for a deep listen. After several more questions and moments of listening, he seems satisfied that Noah's asthma is under control.
"I want you to watch him for the nighttime cough," Boals tells Faulkner. "Watch for cough with exercise. If he's doing that, call, leave a message, and we'll call him in some Flovent or something like that to use through football season."
Although this patient doesn't need any medicine, Boals demonstrates how the prescription system works after he leaves the room. Gone are the days of illegible scribbles on doctors' notepads. Boals can create, sign and fax a prescription to any local pharmacy with just a few clicks of his computer.
"You use about five to 10 medicines frequently, so it's easy to remember that," Boals says. "The different medicines, the things we don't use all the time, we look up. But it's pretty much cut-and-dried."
Lots of Words
Besides knowing which medicines to prescribe, Boals knows to expect plenty of babies coming in for well visits in a block right after lunch.
"You want to try to bring the babies in when there are fewer sick kids here," Boals says.
He enters the examination room to see 10-week-old Jude Heisinger, the son of Joe Heisinger and Mandy Hinson. Jude is a big, healthy baby who is growing well.
"He should smile at me," Boals says to the parents as he approaches Jude. "It's actually a language milestone. It's not a friendly thing. It's them saying, 'Hi.'"
Sure enough, Jude smiles at him.
Language is important to Boals, and he enters the next patient's room armed with a kid's book on tractors. As part of the national "Reach Out and Read" program, the seven pediatricians at Sandhills Pediatrics give an age-appropriate book to every child between 6 months and 5 years at well visits and talk to parents about the importance of reading.
"The number of words a child hears when they're little, the number of words they hear in a day, is directly associated with future school success," Boals says.
Boals speaks a lot of words, making it seem as though his personal mission is to make sure kids -- and parents -- hear as many words as possible in a day. Silent only when using the stethoscope, Boals constantly speaks with parents or babbles about a study or test that has been done on an illness or condition.
And he's just as comfortable talking with kids.
"It's fun talking to 4- and 5-year-olds," Boals says. "They'll talk all the time."
He can easily strike up a conversation about Dora the Explorer, Thomas the Tank Engine or Hannah Montana. He knows the name of one patient's American Girl doll by sight. And get him talking about Disney World and he'll go for hours, one parent says.
"People always wonder why pediatricians get so far behind," Boals says. "Sometimes you've got to talk about stuff."
'Little of Everybody'
Boals isn't running far behind today. By the end of his shift, he will have seen 20 to 30 children in the office. Plus the two children and three newborn babies he saw doing rounds at the hospital this morning. Plus the 16 children he saw at Sandhills Pediatrics' after-hours clinic from 6 to 8 the night before.
"One thing about pediatrics -- it's about volume," Boals says.
He has been busy, but nothing like during flu season, when Sandhills Pediatrics sees as many as 300 children a day.
Although Boals typically sees the same few illnesses over and over, he says the patients he sees are never the same.
"Dr. (Brian) Sherrington calls this place the Wal-Mart of pediatrics," Boals says. "It really is. We get a little of everybody. We get such a great demographic here. We've got the country people. We've got a lot of fairly well-off people. We've got everybody in between. It's a lot of fun. I wouldn't want to be somewhere where it's the same old yuppie medicine all the time."
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